Pin guide and securing means for surgical nail and pin directing apparatus



Jan. 2, 1951 M. F. STEPHENS IN GUIDE SECURING MEANS FOR SURGICAL NAIL AND PIN DIRECTING APPARATUS Filed Oct. 14, 1948 Patented Jan. 2, 1951 UNITED STATES PATENT OFFICE- RIN; AND: SECURING: MEANS. SURGI'EAIH AND BIN" DIRECTING- Ali- RARATI-IS Marion F; Steghens, Sullivan, Ind assignor' to The Giridoscope Corporation, Chicago, Ill-L, a corporation. of Illinois Apnlicatiom October. 14, 194.8,.Serial No. 54,426

Vitallium Smith-Peterson naili'nserted in such a; l

mannerthat" it parallels and. is in. contact with the medial and anterior cortex of the neck" of thefemur'. The guide, commonly called a Steinmann pin, usually about three-thirty-seconds of" an inch by ten inches and is removed from the bore of the nail after the latter has been properly positioned in the fractured neck of the femur; The"Smith-Peterson.nailfor'van adult is about five inches long and has a diameter of fivethirty-seconds of an inch although it is flanged and generally triangular in cross-section. It extends through a hole drilled in the hard outer portion of the femur; the hole extending in line with the center of the acetabulum atflapproxiniatel'y' a 20 anterior angle. The. nail extends through the neck' and preferably" into the head or balk-like portion of the hip=joint, and its. function. is of course to IB-GIIfOI'CE the head on the neck of' the femur. For" the best 'resuilis, the nail must benearly in the direct weight-bearing L'neof the joint and so positioned that it receives the support of the dense corti'cle bone on both sides of the. distal fragment; The insertion of. both the guide pin and the nail must be controlled at all stages by two-plane radiography and in the pasttthes. successful placement oi such fixation devices has; depended largely the senses of; sight and; touch of thevsurgeo-n. and has required av high degree of skill; I

It is further: important that under certain circumstances; such as the taking of 'X-rayphotogranhs, a. nail, a pin, or a. drill: be. secured: in a desired position in directing. apparatus to: prevent movement thereof: during-r exposure; 0bviously it; is necessary that; the. pim or" drill be. guided: accurately and in a. straight line both during operation, and during: 'photogranhy; An important-object of. t e; instant invention is; therefore, to provide. guide apparatus in condimetion with a nail or pin directing; apparatus such,

for example, as. that disclosed, in. my: (so-sending application. Serial No. 5H3, 954r entitled Post Adv Means for Wire; and Na Directing Apparatusinled; January 22;..[1945 and issued 2 Claims: (or mil -92') will ensure accurate directonal' guidance. of the pin ornail, or: drill utilized in conjunction therewith.

It is. a further important objectv of" this. invention to; secure such nail or pin firmly' within the guide means duringsuch'ti'mes as such securing. may be necessary; as, forexampl'e, in connection with the above mentioned X-ray photography.

Still another object of the invention is: the

1 provision of means in association with such: a

guide andsecuring: apparatus; of means for holdiing, a source oifilluminati'on, a camera orthe-lilre in proper alignmentand relatively close:-v relation with the guide means;

Other objects will in part be obvious, and in; part be pointed out as the description of the invention proceeds', and shown in the accompanying drawing wherein there is discloseda pref ierred embodiment of this inventive concept;

} In the drawing:-

Figure 1' is a side elevational viewof one form of guide embodying features of theinstanttinven tion, portions thereof being broken away; and concealed portions being indicated in dotted lines.

Figure 2 is an end elevational view of the structionof Figure l as viewed from the right.

Figure 3 is asectional view take-n substantially along theline 3--3* of Figure 1' asvi'ewed in the direction indicated by the arrows;

Figure 4- is a fragmentary sectional View similarto Figure. 3- disclosing an additional attach-'- mentfor the apparatus:

Figure 5- is a perspective View of the guide member per se dis-associated fromthe-remainder oi the mechanism, and

Figure 6- is: a reduced schematic view disclosing the relationship of the guide member to certain associated mechanism.

Similar reference characters refer to similar parts throughout the several views. of the drawing.

Referring now to the drawing in detail, and particularly toFigurefi the apparatus-withwhich the guide is adapted to be utilized includes: a base plate generally indicated at FE, upon which is mounted a "tubular member H' within is linearly movable a main. supporting postt2; suitable means, forming no part of the instant invention, but more fully described in copending application Serial No. 54AM filed of] even date herewith entitled Mechanism for, Yer:- ticai Adjustment of." SurgicalPin. and Nail. Directi ing Apparatus; is adapted to. be actuated" by means of anoperating wheel [3-, fonvertieel movement of post it.

Means for the rotary adjustment of post I2, and consequently the guide of the instant invention is also provided, and includes a spider I4 and an operating wheel I5, such mechanism being described in detail in my above mentioned patent, and of which the instant application is a continuation in part.

Additional means are also provided for the angular adjustment of guide means in a vertical plane, and include a. protractor I6 secured to one extremity of a square shaft I1, and provided with a collar I8 adapted to be secured to the shaft releasably as by means of a set screw I9. The collar includes a finger which extends to a position between the extremities of two screws 2|, the arrangement being such that these screws 2| may be utilized when set screw |9 secures collar I8 to its associated shaft IT, for relatively small movement of the guide member; or alternatively, upon release of set screw 9 a relatively wide radius of angular adjustment may be provided by movement of protractor I6 independently of finger 29 and its associated screws 2|. The means for effecting such angular adjustment form no part of the instant invention and are described in detail in my co-pending application Serial No. 54,425 filed of even date herewith, entitled Mechanism for Angular Adjustment of Surgical Pin and Nail Directing Apparatus in a Vertical Plane.

Referring now to the guide means of the instant invention in detail, the guide comprises a T- shaped body, as shown in Figure 5, having its cross portion formed with a V-shaped channel and its depending portion or arm in the form of square shank 25. At the lower end of the latter is a transversely-extending fiat-faced notch or recess preferably formed by bifurcating said lower end. The space between the bifurcations of the shank or attaching member is rectangular in cross-section, as indicated at 26, and adapted to seat over a square intermediate portion of shaft I'I, being detachably secured in position as by a screw 21 threaded in a bore extending longitudinally of the shank. The shank 25 is provided with a pair of oppositely disposed shoulders 28 adapted to overlie the arcuate upper ends 29 of shaft supporting bifurcations 30 formed integrally with the upper extremity of supporting post I2. The shank 25 above shoulders 28 has fiat side faces 3| and it is integral with the transversely extending portion 32 of the T-shaped body. The member 32 has a fiat top in which is formed a longitudinally extending angular or V-shaped groove or channel 34 adapted for the reception of a wire or the like, permitting free longitudinal sliding movement of the same in the absence of securing means to be more fully described hereinafter. It will be noted that the channel has two opposed fiat walls which downwardly converge so that cylindrical elements of different diameters will be supported at two circumferentially-spaced points and will be guided in a straight-line path when moved longitudinally in the channel. The projecting ends or arms of the grooved guide member 32 have arcuate bottom faces 33 for convenience in lifting the guide from its support I! when screw 21 is removed.

The depth of the guide groove or channel 34 is such that a large size pin or nail, or a drill or the like will extend above the flat portions of the upper face of the body 32. Such elements may be clamped in position by means of an inverted U-shaped spring clip 3! preferably formed from a strip of suitable resilient sheet metal; The flat top or connecting portion 38 of the clamp engages the projecting portion of the element while the two depending legs or side portions 39 frictionally engage the opposite fiat sides 3| of the shank at the juncture of the latter with the body 32. To permit the clip or clamp to engage pins or wires of smaller diameter such as the element 35 as seen in Figures 1, 2 and 3, the body is formed in its top with a transverse channel 36 which intersects the channel 34 and is of less depth than the latter. The channel 36 extends from one fiat face or area 3| to the other and is sufficiently wide to receive the cross portion 38 of the clip. Such portion may therefore frictionally engage and clamp an element 35 of less thickness than the depth of channel 34.

Under certain conditions, as for example, when a drill or a pin of relatively large diameter is employed, heavier clamping means may be required. To meet such contingency the guide member is provided with a threaded opening or bore 40 extending through the shank at right angles to the channel 3 and from one side 3| to the other, The opening is for the reception of screws 4| which may be provided with knurled heads 42 for the purpose of securing additional apparatus to the guide. One form of such apparatus is disclosed in Figure 4 and takes the form of a C-clamp 43 having a fiat lower end which may be positioned against either face 3| and has an opening through which one of screws 4| is adapted to pass to secure the parts in related assembly. The upper end portion of clamp 43 extends transversely above channel 34 and is provided with a vertically positioned threaded bore within which is positioned a clamping screw 45 provided with a knurled head 46. This screw is perpendicular to said channel and may be readily adjusted to engage an element of rela-- tively large diameter, or cross-sectional area, supported in channel 34. Obviously the clamp 43 may be secured to either side of the appara tus, and equally obviously, alternative apparatus such as a light or a camera may be fastened by either screw 42.

From the foregoing it will now be seen that there is herein provided an improved guide for surgical nails, pins, drills, or the like adapted to be utilized in conjunction with a nail or-pin directing instruments which will effectively serve to guide the nail or pin in the desired direction, and which will further serve to secure or clamp such nail, pin, wire or the like against displacement during such time as such securing may be desirable or necessary,

Iclaim:

l. A wire or nail supporting and guiding means for attachment to an adjustable element of an instrument of the character described, said means comprising an elongated body having an integral depending attaching shank for supporting engagement with an element of an instrument, said shank at its juncture with said body having opposite, flat and parallel side faces, said body having a fiat upper face formed with a central, longitudinally extending V-shaped guide channel, said body also having in its upper face a transversely extending channel intersecting and of less depth than said V-shaped channel, said transverse channel extending from one of said flat faces of said shank to the opposite flat face thereof, whereby an inverted U-shaped clip of resilient sheet metal may have its flat depending ends-in frictional engagement with said flat sides of said shank while its connecting portion is dis posed in said transverse channel to clamp a wire or nail of less thickness than the depth of said V-shaped channel.

2. A device for attachment to an adjustable element of a surgical instrument of the character described and for supporting and guiding a surgical wire, nail, drill or similar element, comprising a T-shaped body having an elongated cross-portion and a depending arm or shank for supporting engagement with an adjustable element of an instrument, said crossportion having a flat top formed with a central V-shaped channel which extends from end-toend of said cross-portion and is upwardly open throughout its length, said channel having opposed, downwardly-converging, flat walls to engage circumferentially-spaced points of cylindrical elements of different diameters and guide them in a straight-line path when moved longitudinally in the channel, said shank at its juncture with said cross-portion being of the same width as the latter and having opposite, flat and parallel side faces, said cross-portion having in its flat top a transversely-extending channel intersecting and of less depth than said V-shaped channel, said transverse channel extending from one of said flat faces of said shank to the opposite flat face thereof, an inverted U-shaped spring clip of resilient sheet metal having flat depending ends to frictionally engage said opposite flat faces of the shank, the top connecting-portion of said clip being movable into and out of said transverse channel to frictional clamp elements of different diameters in said V-shaped channel.

MARION F. STEPHENS.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS Number Name Date 1,994,422 Sasek Mar. 12, 1935 2,226,708 Cleary Dec. 31, 1940 2,267,157 Lippincott Dec. 23, 1941 2,356,591 Jesionowski Aug. 22, 1944 OTHER REFERENCES Zentralblatt fur Chirurgie, for 1934, page 628. 

